Targeting mechanisms of change as a path to precision psychotherapy for community settings.

There have been exciting advancements in mechanisms of change research, but most innovations are rarely applied in community settings. Growing depression rates and clinician shortage call for a significant change in the field. I suggest that mechanisms of change research is a promising path to develop precision psychotherapies for the community. I focus on five key problems and possible solutions to advance psychotherapy through mechanisms research: (1) Depression is heterogeneous and patients' profiles vary. Identifying each patient's unique mechanism can inform precision psychotherapies that target this mechanism; (2) research often relies on self-reports, limiting precision. A multimodal approach with objective measures (e.g., brain, behaviors, voice, language) can improve precise measurement of mechanisms and guide personalization; (3) there is a need for simplified first-line treatments that community therapists can deliver. Simplified psychotherapies and digital interventions can target key mechanisms, enhancing efficacy and cost-effectiveness; (4) methods and technologies are evolving rapidly, no single lab can encompass all necessary expertise. Interdisciplinary collaborations can accelerate mechanisms research; (5) insights from mechanisms research are rarely applied due to academia-clinical practice disconnect. Research-practice networks can develop and tailor targeted psychotherapies for underserved communities. Taken together, discovering key mechanisms of change can improve psychotherapy precision, efficacy and effectiveness in real-world settings.